利妥昔单抗联合CHOP方案治疗弥漫性大B细胞淋巴瘤的临床病理学研究

Clinical-pathological study of diffuse large B-cell lymphoma treated with R-CHOP regimen

目的探讨利妥昔单抗（商品名：美罗华）联合CHOP方案对弥漫性大B细胞淋巴瘤（DLBCL）患者预后的影响。方法收集北京大学基础医学院血液病理研究室确诊的DLBCL患者156例，免疫组织化学方法检测bcl-2、CD10、bcl-6和MUM-1表达情况。根据Hans模型将患者区分为生发中心B细胞样细胞起源组（GCB）和非生发中心B细胞样细胞起源组（non—GCB）；利用Muris分型将DLBCL患者分为低临床风险组（1组）和高临床风险组（2组）；将使用利妥昔单抗联合CHOP方案治疗的患者设为研究组，未使用利妥昔单抗治疗的患者设为对照组。随访全部病例的治疗过程和预后情况。采用SAS8．2统计软件对所得资料进行x^2检验、对数线性模型及Life Table生存分析。结果研究组的30例患者，3年总体生存率783％，对照组的126例患者3年总体生存率53．4％，研究组患者整体预后情况明显好于对照组，二者之间差异有统计学意义（P〈0．05）。研究组和对照组中，Hans模型所区分的不同起源组之间预后差异无统计学意义（P〉0．05）。研究组中Muris模型所区分的1组预后与2组之间差异无统计学意义（P〉0．05）；而对照组中，Muris模型所区分的1组预后明显较2组好，差异有统计学意义（P〈0．05）。bcl-2蛋白表达与对照组患者的预后不良具有较强相关性，而与研究组预后无明显相关。结论使用利妥昔单抗联合CHOP方案化疗能够显著提高DLBCL患者的生存率。利妥昔单抗使用后，bcl-2蛋白表达及Muris模型分组对DLBCL的预后提示作用明显减弱。

Objective To investigate the effect of chemotherapy regimen of rituxmab combined with CHOP （R-CHOP） on the survival of patients with diffuse large B cell lymphoma （DLBCL）. Methods One hundred and fifty-six cases of DLBCL diagnosed according to the WHO 2008 classification were collected from the haematopathological laboratory, the department of pathology, and Beijing University Health Science Center. Standard two-step method of immunohistochemical staining with Envision was used to assess the expression of CD10, MUM-1, bcl-6, and bcl-2. The different classification models were made according to the immunohistochemical staining results. Hans algorithm classifies the patients into two subgroups originating from germinal center B cell-like cell （GCB） and non-germinal center B cell-like cell （non-GCB）, and Muris model were classfied the DLBCL patients into the good-survival groupl and the poor-survival group2. Thirty patients with treatment of R-CHOP were set as study group and the other 126 patients without Retuxmab were defied as control group. The data were analyzed with X^2 test, log-linear model and Life Table survival analysis by the SAS 8.2 statistical package. Results The 3-year survival rate of the study group was 78.3 %, but was 53.4 % in the control group. The over-all survival of the study group was obviously better than the control group with the significant difference （P 〈0.05）. Hans algorithm showed no implication of survival for any group. The survival of different groups in Muris model has no difference in study group but was obvious in control group. The expression of bcl-2 protein has no association with survival in study group but acted as a worse implication of survival in control group. Conclusion R-CHOP chemotherapy regimen could improve the remission rate and over-all survival of DLBCL. Rituxmab could weaken the effect of bcl-2 expression in the prognosis, and the implication of survival by Muris model has diminished.